Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 205533 | LA |
NPI | 1003076647 |
---|---|
Provider Name | Ms. Misty T Wetzel |
First Address | New Orleans, LA 70119-3827 |
Second Address | New Orleans, LA 70119-3827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 15/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104124 | (05) | LA |